Pediatrics ID

banannie's version from 2016-02-29 00:39


Question Answer
causes of pneumonia in children under 5more likely to be viral
causes of pneumonia in children older than 5bacterial
CXR lobar consolidationbacterial
CXR interstitial bronchopneumoniaviral
CXR hyperinflation w. peribronchial marksviral
CXR mild interstitialchlamydophila
CXR streaking, patchyviral pneumonia
age of chlamydia pneumonia1-3 months of age with insidious onset
staccato coughchlamydia pneumonia
CXR confluent lobar consolidationpneumococcal pneumonia
CXR: uni or bi-lateral interstitial pneumonia, looks worse than presentationmycoplasma
CXR: interstitial/lobar pneumonia, looks worse than presentationchlamydia
WBC of viral pneumonia<20k
WBC of bacterial pneumonia15-40k
diagnose viral pneumoniarapid reagents for RSV, parainfluenza, influenza, adenovirus
diagnose bacterial pneumoniaisolate organism from blood, pleural fluid or lung
diagnose mycoplasma pneumoniaIgM titers
MC pneumonia bugsS. pneumo, HiB, S.aureus
MC pneumonia virusesRSV, parainfluenza, influenza, adenovirus
Rx bacterial pneumoniaIV cefuroxime

ToRCHeS infections

Question Answer
chorioretinitis, hydrocephalus, intracanial calcifications, and or blueberry muffin rashtoxo
PDA, cataracts deafness and/or blueberry muffin rashrubella
hearing loss, chorioretinis, seizures, petechial rach, periventricular calcifications and blueberry muffin rash, hepatosplenomegalyCMV
encephalitis. no defects at birthHSV-2
CNVIII deafness, facial abnormalititessyphillitis
what do you give to an HIV positive women during pregnancy to reduce transmission- HAART
- intrapartum AZT
- c-section
- avoid breast feeding
neonatal encephalitis acquired howtypically through the birth canal. usually involves temporal lobes
varicella- limb hypoplasia
- cataracts
- microcephaly

Bugs affecting unimmunized kids

Question Answer
RashRubella: head→down w. postauricular lymphadenopathy
Measles: head→down w preceding cough, coryza, conjunctivitis, Koplik spots on buccal mucosa
MeningitisH. influenza type B - microbe colonizes nasopharynx
Poliovirus - also myalgias and paralysis
PharyngitisCorynebacterium diphtheriae - gray throat - toxin causes necrosis in pharynx, cardiac, and CNS tissue
EpiglottitisH. influenzae type B - fever w dysphagia, drooling, and difficulty breathing d/t edematous "cherry red" epiglottis. Thumbprint sign on x-ray

Red Rashes of Childhood

Question Answer
Rubella virusTogavirus
Rash: begins at head → moves down into fine truncal rash - lasts 3 days
Postauricular lymphadenopathy
Measles RubeolaA paramyxovirus
Rash begins at head and moves down
Rash preceded by cough, coryza, conjunctivitis, blue-white (Koplik) spots on buccal mucosa
Vesicular rash begins on trunk → spreads to face and extremities with lesions of different ages
Macular rash all over body after several days of high fever
can present with febrile seizures
usually affects infants
Parvovirus B19Erythema infectiosum
"Slapped cheek" rash on face
Can cause hydrops fetalis in pregnant women
Strep pyogenesScarlet fever
Erythematous, sandpaper-like rash with fever and sore throat
Coxsackievirus type APicornavirus
Hand-foot-mouth disease
Vesicular rash on palms and soles
Ulcers in oral mucosa

CSF findings in meningitis

Question Answer
Bacterialinc. opening pressure
inc. PMNs
Inc. protein (greater than 250)
Dec. glucose
Fungal/TBInc. opening pressure
Inc. lymphocytes
Inc. proteins
Dec. glucose
ViralNormal/inc. opening pressure
Inc. lymphocytes
Normal/inc. protein (less than 150)
Normal glucose
neutrophilsbacterial meningitis
normal opening pressureviral meningitis
normal glucoseviral meningitis
temporal lobe involvementHSV
encephalitismeningitis + mental status cahnges


Question Answer
First 2 months of lifeGBS, E. Coli, Listeria
2 months to 2 yearsS. pneumo, N. meningitidis, H. Flu
Kernig signflexing of the hip 90 degress and subsequent pain w/leg extension
Brudzinski signinvoluntary flexing of knees and hips after passive flexing of the neck. better test.
neonates therapy for meningitisampicillin and cefotaxime or gentamicin
initial empiric therapy (2 months to 18 years)vancomycin plus either cefotaxime or ceftriaxone
mc sequelae of meningitishearing loss

Viral exanthems

Question Answer
difference between measles and rubellain contrast to measles, children with rubella only have a low grade fever and do not appear as ill
prodome is acute onset of high fever with no other symptomsroseola
complications of roseolafebrile seizures
lesions are at different stages of healingvaricella
worsens with fever and sun exposurefifth disease
gray vesicles/ulcersherpangina cause by cocksackie A virus
treatment for measlessupportive, vitamin A (if deficient)
varicella post-exposure prophylaxisif no history of immunity: if immunocompromised give VZIG w/in 10 days, and if immunocompetent give vaccine
impetigo caused bystaph aureus and GAS
treatment for non-bullous impetigotopical antibiotics
treatment for bullous impetigooral antibiotics


Question Answer
most common cause of lymphadenitis lasting for more than three weeksBartonella
if mother has suspected TB at deliveryseparate baby from mother until chest x-ray obtained
if mother has TBtreat infant w/INH and treat mother w/anti TB therapy until culture negative for three months
diagnosis of lyme (aka borrelia burgdorferri)quantitative ELISA and confirmatory Western blot if Elisa is +
treatment of lymedoxcycline if patients greater than 8 and amoxicillin if patient less than 8
skin rash of RMSFextremities first then spreads rapidly
treatment for RMSFdoxycycline or tetracycline in all patients regardless of age
mc opportunistic infection in HIVPCP
in a child greater than 18 months how should screen for HIVIgG ab by ELISA and confirm w/Western blot
in an infant born to HIV-infected motherinfant should be started on AZT. also start PCP prophylaxis (TMP-SMX) at 1 month
in an infant w/symptons of evidence of immune dysfunction born to HIV positive mothertreat w/ ARTs regardless of age or viral load
loeffler syndromepulmonary ascariasis plus hemoptysis
treatment for pin worm (enterobiasis)single oral dose of mebendazole and repeat in 2 weeks


Question Answer
small poxlive
yellow feverlive
influenza spraylive
salk poliokilled
H fluconjugate
n. meningitidisconjugate
live attenuated vaccinesSmall pox
Yellow fever
Oral polio (sabin)

{Small Yellow Virus OR MMR}
killed vaccinesRabies
Influenza injection
Polio (salk injection)
A Hepatitis

{RIP Always}
recombinant vaccinesHBV, HPV, Borrelia
Toxoid vaccinestetanus, diphtheria, pertussis

{Tdap for Toxoid}
subunit vaccinesH. Flu, N. meningitidis, pneumococcal, typhoid
live vaccineadenovirus


Question Answer
pertussisPCR of nasopharyngeal aspirate 2-4 weeks after cough, or culture
bartonellaPCR and warthrin starry stain
TBMantoux (PPD) 4-8 weeks after exposure cxr
LymeQuantitative ELISA with confimatory western blot
candida albicansskin scrapings and KOH
cryptococcus neoformanslatex agglutination, cryptococcal antigen in serum
bacterial pneumoniaCXR lobar consolidation, sputum C&S, blood culture
viral pneumoniaCXR bronchopneumonia, intersitial
chalmydia pneumoniasputum PCR
mycoplasma pneumoniaPCR of NP
EBVhetrophyle antibodies, IgM to viral capsid (IgM-VcA-EBV) is most specific!
influenzaELISA rapid test, confirm serologic titers or PCR


Question Answer
bacterial meningitis <3 monthsAmpicillin and Cefotaxime
bacterial meningitis >3monthsVancomycin and Ceftriaxone
prophylaxis for neisseria meningitisRifampin
meningococcal meningitisIV penicillin ASAP
viral meningitisacyclovir if HSV
treatment for pertussiserythromycin x14 days, may shorten course & close contacts
lyme<8 yo amoxicillin, +ceftriaxone for meningitis or carditis
> 8 yo doxycycline x14-21 days
rickettsia rickettsiidoxy or tetracycline
candida albicansoral nystatin
single dose fluconazole if recurrent
cryptococcus neoformansoral fluconazole 3-6 months
Amphotericin B + flucytosine for severe
itraconazole if not improved
amphotericin B for pulmonary or disseminated disease
rubeola measlesvitamin A
rubella measlessupportive
UTI <1 month : ampicillin+cefotaxime
Question Answer
UTI >1 month3rd generation cephalosporin
otitis mediahigh dose amoxicillin (+clavulanate for persistent)
allergies: azithromycin, clindamycin, cephalosporins, levoquine
strep pneumoniaampicillin/clavulanate
IV amp/sulbactam
severe pneumonia <6 months : IV ceftriaxone, cefotaxime
Vancomycin if ICU
Question Answer
pneumonia > 5 yomacrolides, for atypical pneumonias
nontender lymphadenitisobservation
tender lymphadenitis, otherwise wellCover MRSA and GAS
oral clindamycin
tender lymphadenitis, illIV clindamycin, vancomycin or linezolid + drainage
nonpurulent cellulitiscephalexin, clindamycin, dicloxacillin
purulent cellulitisIV clindamycin, vancomycin, linezolid
preseptal cellultisclindamycin
empiric orbital cellulitisVancomycin + Ceftriaxone
orbital cellulitis, r/o intracranial extensionClindamycin+Ceftriaxone
orbital cellulitis w. intracranial extensionMetronidazole
bacterial arthritis <3 months : IV vancomycin + cefotaxime
Nafcillin + Gentamicin
Question Answer
bacterial arthritis 3 months-3years, not acutely illClindamycin with cephalosporin if suspicious of gram negative
bacterial arthritis >3 yearspenicillin or cephalosporin
- increased rates of s.aureus
osteomyelitiscefotaxime + vancomycin/nafcillin
- MRSA, s. pneumo, g-
giardiametronidazole, furazolidone
influenza, within 48 hoursoseltamivir (neuraminidase inhibitor)
conjunctivitis (opthalmia neonatorum)erythromycin PO and ceftriaxone (N.gonorrhea)